Provider Demographics
NPI:1760424394
Name:PREMIER CARE SIMI VALLEY LLC
Entity Type:Organization
Organization Name:PREMIER CARE SIMI VALLEY LLC
Other - Org Name:SIMI VALLEY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-497-7330
Mailing Address - Street 1:3075 E THOUSAND OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3402
Mailing Address - Country:US
Mailing Address - Phone:805-497-7330
Mailing Address - Fax:805-497-7440
Practice Address - Street 1:5270 E LOS ANGELES AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-4137
Practice Address - Country:US
Practice Address - Phone:805-522-9155
Practice Address - Fax:805-527-9915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55701FMedicaid
CA55-5701Medicare ID - Type Unspecified